Individual
BRANDON RYSAVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
500 W. FORT ST., # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Mailing address
500 W. FORT ST., # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ED0475A
WV
207R00000X
Internal Medicine Physician
Primary
O-1196
ID
Other
Enumeration date
08/05/2014
Last updated
03/15/2022
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